Provider Demographics
NPI:1578353504
Name:MALEC, KENZIE PAIGE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:KENZIE
Middle Name:PAIGE
Last Name:MALEC
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:KENZIE
Other - Middle Name:PAIGE
Other - Last Name:BERGGREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:6157 N SHERIDAN RD APT 9A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-2818
Mailing Address - Country:US
Mailing Address - Phone:815-383-7179
Mailing Address - Fax:
Practice Address - Street 1:6501 S PROMONTORY DR # 1003
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-1002
Practice Address - Country:US
Practice Address - Phone:815-383-7179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490282891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical